The hypoxic tumor microenvironment has been shown to contribute to genetic instability. As one possible mechanism for this effect, we report that expression of the DNA mismatch repair (MMR) gene Mlh1 is specifically reduced in mammalian cells under hypoxia, whereas expression of other MMR genes, including Msh2, Msh6, and Pms2, is not altered at the mRNA level. However, levels of the PMS2 protein are reduced, consistent with destabilization of PMS2 in the absence of its heterodimer partner, MLH1. The hypoxia-induced reduction in Mlh1 mRNA was prevented by the histone deacetylase inhibitor trichostatin A, suggesting that hypoxia causes decreased Mlh1 transcription via histone deacetylation. In addition, treatment of cells with the iron chelator desferrioxamine also reduced MLH1 and PMS2 levels, in keeping with low oxygen tension being the stress signal that provokes the altered MMR gene expression. Functional MMR deficiency under hypoxia was detected as induced instability of a (CA) 29 dinucleotide repeat and by increased mutagenesis in a chromosomal reporter gene. These results identify a potential new pathway of genetic instability in cancer: hypoxia-induced reduction in the expression of key MMR proteins. In addition, this stress-induced genetic instability may represent a conceptual parallel to the pathway of stationary-phase mutagenesis seen in bacteria.It has been argued that the large number of mutations found in malignant cells cannot be accounted for by the low rate of mutation generally found among somatic cells, leading to the suggestion that there is a mutator phenotype in cancer (26). The basis for this genetic instability has not been fully established. Much work has focused on the role of genetic defects in cancer cells affecting cell cycle regulation and DNA repair that could lead to genomic instability, such as in p53 (18). Hereditary nonpolyposis colon carcinoma is linked to inherited defects in several of the human DNA mismatch repair (MMR) genes, including Msh2, Mlh1, and Pms2 (29). Another cancerprone syndrome, xeroderma pigmentosum, affects individuals with mutations in genes associated with the nucleotide excision repair (NER) pathway (56).As an alternative mechanism by which genetic instability might arise in cancer, we and others have investigated the possible role of the tumor microenvironment (61). Developing tumors form a unique tissue environment because their growth outstrips their blood supply, leading to hypoxia, low pH, and nutrient deprivation (39, 55). Several studies have shown that hypoxia can alter chromosome metabolism, leading to gene amplification and fragile site induction (11, 37, 60). Our prior work found that cells exposed to hypoxia in culture have increased frequencies of point mutations at reporter gene loci (36). In addition, experimental tumors grown from cells implanted into mice show elevated levels of mutations compared to the same cells grown in parallel in normoxic culture, pointing to a deleterious effect of the tumor microenvironment on genome integrity in v...